We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Economic Impact of Surgical Complications on Hospitals—Reply ONLINE FIRST

Mark A. Healy, MD, MS1,2,3; Justin B. Dimick, MD, MPH1,2,3,4
[+] Author Affiliations
1Department of Surgery, University of Michigan, Ann Arbor
2Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
3Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor
4Surgical Innovation Editor, JAMA Surgery
JAMA Surg. Published online August 31, 2016. doi:10.1001/jamasurg.2016.2309
Text Size: A A A
Published online


In Reply The letters by Chidambaram et al and Rosenberg et al raise an important point regarding the evaluation of the contribution margin and the total profit margin in the context of hospital cost accounting. Eappen et al,1 in their seminal JAMA article from 2013, studied a 12-hospital system in Georgia demonstrating evidence of perverse financial incentives for hospitals when surgical complications occur. They chose to study the contribution margin, an important factor for the short-term financial well-being of hospitals, for all of the reasons that they have outlined in their study.1 In our study, we chose to primarily evaluate the total profit margin, including fixed costs, as it relates to long-term financial solvency for hospitals. Moreover, this is an important perspective for hospitals at or near full operating room capacity, such as many large academic health systems.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





August 31, 2016
Swathikan Chidambaram, BSc(Hons); En Lin Goh, BSc(Hons); Simon Erridge, BSc(Hons)
1School of Medicine, Imperial College London, London, England
JAMA Surg. Published online August 31, 2016.;():. doi:10.1001/jamasurg.2016.2307.
August 31, 2016
Barry Rosenberg, MD, MBA; Bennett Lane, MS; Atul Gawande, MD, MPH
1The Boston Consulting Group, Chicago, Illinois
2Harvard Medical School, Boston, Massachusetts
3Ariadne Labs, Brigham and Women’s Hospital and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Surg. Published online August 31, 2016.;():. doi:10.1001/jamasurg.2016.2308.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...